MEDICARE: MS. CAROL SPECTER NEMEROV OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT004284	GA

General Provider Information

NPI Number	:	1942214945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL SPECTER NEMEROV OTR/L

Provider Business Mailing Address
First Line	:	3347 RIVER HEIGHTS XING SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4861
Country	:	US
Telephone Number	:	770-980-9276
Fax Number	:	770-980-9276

Provider Business Practice Location Address
First Line	:	3347 RIVER HEIGHTS XING SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4861
Country	:	US
Telephone Number	:	770-980-9276
Fax Number	:	770-980-9276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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